PMT18-00576 City of Menifee Permit No.: PMT18-00576
29714 HAUN RD. Type: Mobile Home
�ACCEI/�. MENIFEE, CA 92586
MENIFEE Date Issued: 0 310 812 01 8
PERMIT
Site Address: 27957 JEFFERSON AVE, MENIFEE, CA Parcel Number: 329-182-005
92585 Construction Cost: $85,000.00
Existing Use: Proposed Use:
Description of PERMANENT FOUNDATION FOR REPLACEMENT 1,792 SO FT MOBILE
Work:
SN: 13510503A/8
HUD:ARZ100200l201
Owner Contractor
LILIA AND HILARIO TERRONES
37517 EARLY LANE
MURRIETA, CA 92563
Applicant License Number:
LILIA AND HILARIO TORRENES
37517 EARLY LANE
MURRIETA,CA 92563
Phone:9512650413
Fee Description -0ty Amount IS1
Manufactured Permanent Foundation 1 240.72
Permit Fee 1 27.00
$267.72
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunderwhen in violation of the Building Code or of any other
ordinance of City of Menlfee.Except as otherwise stated,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit Template.rpt Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
I hereby affirm under penalty of perjury that I am under provisions of with a licensed contractor(s)pursuant to the Contractors State License Law).
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑I am exempt from licensure under the Contractor's State License Law for
Professions Code and my license is in full force and effect. the following reason:
License Class License No.
By my signature below 1 acknowledge that,except for my personal residence
Expires Signature in which I must have resided for at least one year prior to completion of
WORKER'S COMPENSATION DECLARATION improvements covered by this permit.I cannot legally sell a structure that I
have built as an owner-builder if it has not been constructed in its entirety by
o I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website:
by Section 3700 of the Labor Code,for the performance of work for which
this permit Is Issued. www.le info.ca. ov calaw.html.
Policy# -( WPA e( Date 31 2O\
❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which D By my signature below I certify to each of the following:I am the property
this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
Carrier with all applicable city and county ordinances and state laws relating to
building construction.I authorize representatives of this city or county to
Policy# Expires enter he above identified property for inspection purposes.
d
(This section need not to be completed Is the permit is for one-hundred �t \dollars($1GO)or less
PROPERTY OWNER OR AUTHORIZED AGEM
o 1 certify that in the performance of the work for which this permit is issued,
I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that if 1 should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions. Will the applicant or future building occupant handle hazardous material or a
Applicant Date mixture containing a hazardous material equal to or greater that the
amounts specified an the Hazardous Materials Information Guide?
WARNING:FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS oYes DNo
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ion occupant require a permit for the construct or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SC ion or See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines
CONSTRUCTION LENDING AGENCY ❑Yes o No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boundary of a school?
(Section 3097 Civil Code) o Yes D No
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
I hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements under the State of
Contractors License Law for the reason(s)indicated below by the California Health&Safety Code,Section 25505 and 25534 concerning
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 hazardous material reporting.
Business and Professions Code).Any city or county that requires a permit to oYes o No
construct,alter,Improve,demolish or repair any structure,prior to its Date
issuance,also requires the applicant for the permit to file a signed statement PROPERTY OWNER OR AUTHORIZED AGENT
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in apre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to beork that disturbs
d rums and comply with
thanApplicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500).
managers who do the paint-disturbing work themselves or through their
o 1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.eov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not apply to an owner of a ❑An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or Improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No.:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
o I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply With EPA RRP rule please fill out the RRP
Acknowledgement.
SAFETYBUILDING & . • . •
Menifee
DATE: .11,1111k.-PERMIT/PLAN CHECK NUMBER D or)
TYPE: O COMMERCIAL O RESIDENTIAL O MULTI-FAMILY +a MOBILE HOME O POOL/SPA O SIGN
SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL
�JEW O PLUMBING 0 RE-ROOF NUMBER OFSQUARES
DESCRIPTION OF WORK
PROIECTADDRESS %7I57 ,�ET-f'YySO/I I4vP A0110101/L� ZIP q
ASSESSOR'S PARCEL NUMBER LOT f�� TRACT
OWNER NAME ' � J //' ip e5
ADDRESS ( 2.
C 6157
PHONE �S� (, S-/fy/3 EMAIL r / .Ce m
APPLICANT NAME
ADDRESS
PHONE EMAIL /'
CONTRACTOR'S NAME OWNER BUILDER? * ES ONO
BUSINESS NAME
ADDRESS
PHONE EMAIL
CONTRACTOR'S STATE LIC NUMBER LICENSE CLASSIFICATION
VALUATION$ SO.FT l 792 L SQ FT 0
`
APPLICANT'S SIGNATURE J)c' —T2VV1)Y1e)' DATE
CITY STAFF USE ONLY
DEPARTMENT DISTRIBUTION CITY OF ryl FEE BUSINESS LICENSE NUMBER
ACCEPTED BY• 7w\ [/
BUILDING PLANNING ENGINEERING FIRE
PERMIT FEE o1�Q1.,�' SMIP GREEN
PLAN CHECK FEE INVOICE TOTAL
OWNER BUILDER VERIFIED 0 YES O NO DRIVERS LICENSE# NOTARIZED LETTER O YES O NO
City of klenifee
City of Menifee Building&Safety Department 29714 Houn Rd. Menifee, CA 925 9 1-672-6777
www.cityofinenifee.uus �� U 9 alp
Received
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r 'Approval of these plans shag not be construed to a pennittor,or an
\approvat of,any violation of any provisions of the feI-eral,state or city If!
regulations and ordinances. This set of approv 6t be kept on the - —�—
job te unri!completion. i t
/4 /-07- 71